HomeMy WebLinkAboutPlumbing Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 06/22/2020 Permit Number:
PLTC U,LE
O ' ,
V ` L L`t ---- Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial xx Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 3100 N Hwy A1A Unit 503
Property Tax ID #: 1425-606-0013-000-2 Lot No.
Site Plan Name: Sands on the Ocean Block No.
Project Name:
-- -- - -�
DETAILED DESCRIPTION OF WORK:
Furnish and install 38 gallon lowboy electric hot water heater
New Electrical Meter Second Electrical Meter
� CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors Pond
Electric _ Plumbing A Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq_ Ft. of First Floor:
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Joesph Kulikowski
Name: Daniel Washburn
Address:3300 Raymond Road
Company:Ace Plumbing, Inc.
City: Sanborn State:
Address:665 4th Place
Zip Code: 14132 Fax:
Phone No.772-595-6485
City: Vero Beach State: FI
Zip Code: 32962 Fax: 772-567-8494
E-Mail:
Phone No 772-562-3780
Fill in fee simple Title Holder on next page { if different
E-Mail ace. plumbing@comcast.net
from the Owner listed above)
State or County LicenseCFC032636
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If vaiue of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. II
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or
Please
structure. prohibit such
consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie Cou ty and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
wi len or an attorne before commencin work or rec rdin our Notice of Commencement.
O�
Si n ture of Owner/ Lessee/Contractor as Agent for Owner Signa ure 3TContractorTUice se Holder
STATE OF FLQRID� STATE OF FLQI�ID1
COUNTY OF NK'N ��1 '�t�( COUNTY
OF \\��``�� \\��>>`1
Sworn to (or affirmed) and subscribed before me of Swprn to (or affirmed) and subscribed before me of
Physical
Pcrgience or Online Notarization Physical Prince or Online Notarization
th day of ���pt Z 2020 by this day of 2020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
duced duced
(Signakure of Notary PubASta4f: '�da) ANotaryPublic-StateofFlorinature of Notary Public -State F oFi a APRIRENEECARINI
• �1 •' commission # GG 121631 : r` .`- : Notary Public -State of FI(ri i
Commission N ,.r al)Mycomm. Expires1u120.20 1Co missN� Qi31� CommisslanGGt216 t
''".,`,;;••'• 6crdedtPrcugPAati�ralNetuyAsn. :'' ` My Comm. Expires Jul 20. 0
;.'.;.: BergFett raay� natrcrai hotar hs
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
---- BUILDING & CODE REGULATION DIVISION
J ' = 2300 VIRGINIA AVENUE
• FORT PIERCE FL 34982
"= 772-462-1553
FAX 772-462-1578
AUTHORIZATION FORM FOR CREDIT CARD PAYMENT
TO: St Lucie County
RE: _j % C)Cj / i4 S2z3
Permit #
Credit Card Users: 1,5010 Surcharge added per transaction.
Payments must be received in this department by 4:00 PM for transaction to be
processed that day, if not it will be processed the following business day.
VISA k—'MASTERCARD
Credit Card Number Sal (Dare %1Di2 LJ D �%/ Z /p -7S 5
Expiration Date �S` Z- z Zip Code 3 a cj�i
3 digit security code
Amount $ + 1.5% surcharge
Business Name:
Authorized Signature:
Print Name:,
Phone: (7 -1 -�-' ) �(pZ - 3 W� C)
Fax: ('77 Z- ) 5 t�.� - � (-i 9 q
Comments:
SLCPDSD Revised 4/01/2010 EN